Peripheral Nerve Blockade for Open Inguinal Hernia Repair in a Patient With Severe Cardiopulmonary Disease

Abstract

Patients with severe cardiopulmonary morbidity present a unique challenge to peri- and intraoperative providers. Inducing general anesthesia in this patient population poses the risk of adverse events that could lead to poor surgical outcomes, prolonged debilitation, or death. Therefore, it is important that anesthesiologists become comfortable with preoperative evaluation as well as alternative strategies to providing surgical anesthesia. This case report details the clinical course of a patient with severe cardiopulmonary morbidity who underwent open inguinal hernia repair without oral or intravenous sedation after receiving multi-level paravertebral blocks in addition to isolated ilioinguinal and iliohypogastric nerve blocks. This medically challenging case provides educational value regarding preoperative evaluation, pertinent anatomy and innervation, and the importance of patient-centered care and communication.

Keywords: academic anesthesiology; acute pain management; anatomy; inguinal hernia repair; local anesthesia; lumbar plexus; paravertebral block (pvb); paravertebral space; regional anesthesiology.

Figure 1. The patient's preoperative chest x-ray, which shows an enlarged cardiomediastinum.

Figure 2. An ultrasound image of the patient's ilioinguinal/iliohypogastric nerve block was captured at the time of the procedure.

Figure 3. American College of Surgeons Surgical Risk Calculator displaying a comprehensive list of possible postoperative complications for this patient.